Chapter 99

Health Care Providers

 

Subchapter 1 — General Provisions

 

[Reserved]

 

Subchapter 2 — Patient Protection Act of 1995

 

23-99-201. Short title.

 

This subchapter may be cited as the “Patient Protection Act of 1995”.

 

23-99-202. Legislative findings and intent.

 

The General Assembly finds that patients should be given the opportunity to see the health care provider of their choice. In order to assure the citizens of the State of Arkansas the right to choose the provider of their choice, it is the intent of the General Assembly to provide the opportunity of providers to participate in health benefit plans.

 

23-99-203. Definitions.

 

(a)(1)  “Copayment” means a type of cost sharing whereby insured or covered persons pay a specified predetermined amount per unit of service or percentage of health care costs with their health care insurer paying the remainder of the charge.

            (2)  The copayment is incurred at the time the service is rendered.

            (3)  The copayment may be a fixed or variable amount.

(b)  “Gatekeeper system” means a system of administration used by any health benefit plan in which a primary care provider furnishes basic patient care and coordinates diagnostic testing, indicated treatment, and specialty referral for persons covered by the health benefit plan.

(c)  “Health benefit plan” means any entity or program that provides reimbursement, including capitation, for health care services, except and excluding any entity or program that provides reimbursement and benefits pursuant to Arkansas Constitution, Amendment 26, Acts 1993, No. 796, or the Public Employee Workers' Compensation Act, § 21-5-601 et seq., and rules, regulations, and schedules adopted thereunder.

(d)  “Health care provider” means those individuals or entities licensed by the State of Arkansas to provide health care services, limited to the following:

            (1)  Advanced practice nurses;

            (2)  Athletic trainers;

            (3)  Audiologists;

            (4)  Certified orthotists;

            (5)  Chiropractors;

            (6)  Community mental health centers or clinics;

            (7)  Dentists;

            (8)  Home health care;

            (9)  Hospice care;

            (10)  Hospital-based services;

            (11)  Hospitals;

            (12)  Licensed ambulatory surgery centers;

            (13)  Licensed certified social workers;

            (14)  Licensed dieticians;

            (15)  Licensed professional counselors;

            (16)  Licensed psychological examiners;

            (17)  Long-term care facilities;

            (18)  Occupational therapists;

            (19)  Optometrists;

            (20)  Pharmacists;

            (21)  Physical therapists;

            (22)  Physicians and surgeons (M.D. and D.O.);

            (23)  Podiatrists;

            (24)  Prosthetists;

            (25)  Psychologists;

            (26)  Respiratory therapists;

            (27)  Rural health clinics; and

            (28)  Speech pathologists.

(e)  “Health care services” means services and products provided by a health care provider within the scope of the provider's license.

(f)  “Health care insurer” means any entity, including, but not limited to:

            (1)  Insurance companies;

            (2)  Hospital and medical service corporations;

            (3)  Health maintenance organizations;

            (4)  Preferred provider organizations;

            (5)  Physician hospital organizations;

            (6)  Third party administrators; and

            (7)  Prescription benefit management companies,

authorized to administer, offer, or provide health benefit plans.

 

23-99-204. Terms of health benefit plan.

 

(a)  A health care insurer shall not, directly or indirectly:

            (1)(A)  Impose a monetary advantage or penalty under a health benefit plan that would affect a beneficiary's choice among those health care providers who participate in the health benefit plan according to the terms offered.

                        (B)  “Monetary advantage or penalty” includes:

                                    (i)  A higher copayment;

                                    (ii)  A reduction in reimbursement for services; or

                                    (iii)  Promotion of one (1) health care provider over another by these methods;

            (2)  Impose upon a beneficiary of health care services under a health benefit plan any copayment, fee, or condition that is not equally imposed upon all beneficiaries in the same benefit category, class, or copayment level under that health benefit plan when the beneficiary is receiving services from a participating health care provider pursuant to that health benefit plan; or

            (3)  Prohibit or limit a health care provider that is qualified under § 23-99-203(d) and is willing to accept the health benefit plan's operating terms and conditions, schedule of fees, covered expenses, and utilization regulations and quality standards, from the opportunity to participate in that plan.

(b)  Nothing in this subchapter shall prevent a health benefit plan from instituting measures designed to maintain quality and to control costs, including, but not limited to, the utilization of a gatekeeper system, as long as such measures are imposed equally on all providers in the same class.

 

23-99-205. Construction.

 

(a)  Nothing in this subchapter shall be construed to require any health care insurer to cover any specific health care service.

(b)  Provided, however, no condition or measure shall have the effect of excluding any type or class of provider qualified under § 23-99-204(a)(3) to provide that service.

 

23-99-206. Violations.

 

It is a violation of this subchapter for any health care insurer or other person or entity to provide any health benefit plan providing for health care services to residents of this state that does not conform to this subchapter, but nothing in this subchapter shall constitute a violation on the basis of actions taken by the health benefit plan to maintain quality, enforce utilization regulations, and to control costs.

 

23-99-207. Civil penalties.

 

To the extent permitted by ERISA, the federal Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq., any provider adversely affected by a violation of this subchapter may sue in circuit court only for injunctive relief against the health care insurer, but not for damages. The prevailing party shall be allowed a reasonable attorney's fee and costs.

 

23-99-208. Void provisions.

 

(a)  To avoid impairment of existing contracts, this subchapter shall only apply to contracts issued or renewed after July 28, 1995.

(b)  Any provision in a health benefit plan which is executed, delivered, or renewed, or otherwise contracts for provision of services in this state that is contrary to this subchapter, shall, to the extent of the conflict, be void.

 

23-99-209. Applicability.

 

The provisions of this subchapter shall not apply to self-funded or other health benefit plans that are exempt from state regulation by virtue of the Employee Retirement Income Security Act of 1974, as amended.

 

Subchapter 3 — Primary Eye Care Provider Act

 

23-99-301. Short title.

 

This subchapter shall be known and may be cited as the “Primary Eye Care Provider Act”.

 

23-99-302. Definitions.

 

As used in this subchapter:

            (1)  “Covered persons” means any individual or family that is enrolled in a health benefit plan or policy from a health care insurer and on whose behalf the health care insurer is obligated to pay for or provide eye and/or vision care benefits;

            (2)  “Covered service” means those health care services; including eye and/or vision care benefits, which the health care insurer is obligated to pay for or provide to covered persons under the health benefit plan or policy;

            (3)(A)  “Eye and/or vision care benefits” means those services and materials which are provided by a primary eye care provider who is functioning within the scope of his or her license.

                        (B)  The conditions imposed by any specific health benefit plan upon the provision of eye and/or vision care benefits shall not:

                                    (i)  Prohibit the primary eye care provider from providing covered services to covered persons at his or her highest level of licensure and competence at any given time, as determined by his or her respective licensing board; or

                                    (ii)  Require that the primary eye care provider hold hospital staff privileges or include any other condition as a requirement which would have the practical effect of excluding any class of provider from participation in the plan;

            (4)  “Gatekeeper” means a covered person's primary care provider in a gatekeeper system;

            (5)  “Gatekeeper system” means a system of administration used by any health benefit plan in which a primary care provider furnishes basic patient care and coordinates diagnostic testing, indicated treatment, and specialty referral for persons covered by the health benefit plan;

            (6)  “Health benefit plan” means any public or private health plan, program, policy, subscriber agreement, or contract implemented in the State of Arkansas which includes or may include payment, reimbursement, including capitation, or financial compensation for provision of eye and/or vision care benefits to covered persons but does not include workers' compensation coverage or reimbursement;

            (7)  “Health care insurer” means any entity, including, but not limited to, insurance companies, hospital and medical service corporations, health maintenance organizations, preferred provider organizations, and physician hospital organizations, that is authorized by the State of Arkansas to offer or provide health benefit plans, policies, subscriber contracts, or any other contracts of a similar nature which indemnify or compensate health care providers for the provision of health care services; and

            (8)  “Primary eye care provider” means an ophthalmologist or optometrist licensed by the State of Arkansas who has been selected by a person covered by a health benefit plan to provide eye and/or vision care benefits and who agrees to provide these services in accordance with the terms, conditions, reimbursement rates, and standards of quality as set forth within the specific health benefit plan.

 

23-99-303. Requirements for health benefit plans.

 

A health benefit plan that includes, or may include, eye and/or vision care benefits shall:

            (1)  Include all primary eye care providers who are selected by covered persons of the plan for the provision of all eye and/or vision care benefits provided by the plan;

            (2)  Permit any licensed optometrist or ophthalmologist who agrees to abide by the terms, conditions, reimbursement rates, and standards of quality of the health benefit plan to serve as a primary eye care provider to any person covered by that plan;

            (3)  Guarantee that all covered persons who are eligible for eye and/or vision care benefits under a health benefit plan shall have direct access to the primary eye care provider of their choice independent of, and without referral from, any other provider or entity;

            (4)(A)  Assure that those plans utilizing a gatekeeper system shall designate the primary eye care provider as the gatekeeper who shall provide basic patient care and coordinate diagnostic testing, indicated treatment, and specialty referral for those covered persons in the provision of eye and/or vision care benefits.

                        (B)(i)  Nothing in this subchapter shall prevent a covered person from having direct access to that person's primary care provider, or gatekeeper, for the treatment of eye disease or injury and being reimbursed in accordance with the terms and fee schedule of the health benefit plan.

                                    (ii)  However, nothing contained in this subchapter shall require payment of the monthly patient management fee by the Arkansas Medicaid Program to a primary eye care provider gatekeeper;

            (5)  Not discriminate between individual providers or classes of providers in the amount of reimbursement, copayment, or other financial compensation for the same or essentially similar services provided by the health benefit plan;

            (6)  Not promote or recommend any individual provider or class of providers to a covered person by any method or means;

            (7)  Assure that all primary eye care providers selected by persons covered by a health benefit plan are included on the list of participating providers of the plan;

            (8)  Assure that an adequate number of primary eye care providers are included to guarantee reasonable accessibility, timeliness of care, convenience, and continuity of care to covered persons; and

            (9)  Make available to covered persons a listing of all primary eye care providers, their practice locations, and telephone numbers on a regular, timely basis.

 

23-99-304. Subchapter not to prevent treatment.

 

Nothing in this subchapter shall prevent any person covered by a health benefit plan from receiving emergency eye care nor shall it prevent any person from exercising his or her right to receive treatment from his or her personal doctor and being reimbursed in accordance with the terms and fee schedule of the health benefit plan.

 

23-99-305. Remedies.

 

Any person adversely affected by a violation of this subchapter may bring action in a court of competent jurisdiction for injunctive relief against the health care insurer and, upon prevailing, in addition to such injunctive relief, shall recover damages not less than one thousand dollars ($1,000) plus attorney's fees and costs.

 

Subchapter 4 — Arkansas Health Care Consumer Act

 

23-99-401. Short title.

This subchapter shall be known and may be cited as the “Arkansas Health Care Consumer Act”.

 

23-99-402. Legislative findings and intent.

 

As the state's insurance sector becomes increasingly dominated by managed care features that include decisions regarding coverage and appropriateness of health care, there is a vital need to protect patients in this environment.

 

23-99-403. Definitions.

 

As used in this subchapter:

            (1)  “Acute condition” means a medical condition, illness, or disease having a short and relatively severe course;

            (2)  “Commissioner” means the Insurance Commissioner;

            (3)  “Covered person” means a person on whose behalf the health care insurer issuing or delivering the health benefit plan is obligated to pay benefits pursuant to the health benefit plan;

            (4)(A)  “Health benefit plan” means any individual, blanket, or group plan, policy, or contract for health care services issued or delivered by a health care insurer in this state, including indemnity and managed care plans and including self-insured governmental and church plans, but excluding plans providing health care services pursuant to Arkansas Constitution, Article 5, § 32, the Workers’ Compensation Law, § 11-9-101 et seq., and the Public Employee Workers’ Compensation Act, § 21-5-601 et seq.

                        (B)  “Health benefit plan” does not include an accident-only, specified disease, hospital indemnity, long-term care, disability income, or other limited-benefit health insurance policy;

            (5)  “Health care insurer” or “insurer” means any insurance company, hospital and medical service corporation, or health maintenance organization issuing or delivering health benefit plans in this state and subject to the following laws:

                        (A)  The Arkansas Insurance Code;

                        (B)  Section 23-76-101 et seq., pertaining to health maintenance organizations;

                        (C)  Section 23-75-101 et seq., pertaining to hospital and medical service corporations; and

                        (D)  Any successor laws of the foregoing;

            (6)  “Managed care plan” means a health benefit plan that either requires a covered person to use or creates incentives, including financial incentives, for a covered person to use participating providers;

            (7)(A)  “Orthotic device” means an external device that is:

                                    (i)  Intended to restore physiological function or cosmesis to a patient; and

                                    (ii)  Custom-designed, fabricated, assembled, fitted, or adjusted for the patient using the device prior to or concurrent with the delivery of the device to the patient.

                        (B)  “Orthotic device” does not include a cane, a crutch, a corset, a dental appliance, an elastic hose, an elastic support, a fabric support, a generic arch support, a low-temperature plastic splint, a soft cervical collar, a truss, or other similar device that:

                                    (i)  Is carried in stock and sold without therapeutic modification by a corset shop, department store, drug store, surgical supply facility, or similar retail entity; and

                                    (ii)  Has no significant impact on the neuromuscular, musculoskeletal, or neuromusculoskeletal functions of the body;

            (8)  “Orthotic service” means the evaluation and treatment of a condition that requires the use of an orthotic device;

            (9)  “Participating provider” means a provider who or that has agreed to provide health care services to covered persons with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, directly or indirectly, from the health care insurer;

            (10)  “Person” or “entity” means and includes, individually and collectively, any individual, corporation, partnership, firm, trust, association, voluntary organization, or any other form of business enterprise or legal entity;

            (11)  “Policyholder” means the employer, union, individual, or other person or entity that purchases, issues, or sponsors a health benefit plan;

            (12)(A)  “Prosthetic device” means an external device that is:

                                    (i)  Intended to replace an absent external body part for the purpose of restoring physiological function or cosmesis to a patient; and

                                    (ii)  Custom-designed, fabricated, assembled, fitted, or adjusted for the patient using the device prior to or concurrent with being delivered to the patient.

                        (B)  “Prosthetic device” does not include an artificial eye, an artificial ear, a dental appliance, a cosmetic device such as artificial eyelashes or wigs, a device used exclusively for athletic purposes, an artificial facial device, or other device that does not have a significant impact on the neuromuscular, musculoskeletal, or neuromusculoskeletal

functions of the body;

            (13)  “Prosthetic service” means the evaluation and treatment of a condition that requires the use of a prosthetic device;

            (14)  “Specialty” means a provider’s particular area of specialty within his or her licensed scope of practice; and

            (15)  “Type” of provider means the licensed scope of practice.

 

23-99-404. Benefits for mothers and newborns.

 

(a)(1)  Except as provided in subsection (b) of this section, a health care insurer may not restrict benefits for any hospital stay in connection with childbirth for the mother or newborn child to less than forty-eight (48) hours following a normal vaginal delivery or to less than ninety-six (96) hours following cesarean section.

            (2)  A health care insurer may not require that a provider obtain authorization for prescribing any length of stay required under subdivision (a)(1) of this section.

(b)  Subdivision (a)(1) of this section shall not apply if the decision to discharge the mother or her newborn child prior to the expiration of the minimum stay is made by the attending physician in consultation with the mother.

 

23-99-405. Mastectomies.

 

(a)  Every health benefit plan providing mastectomy benefits and issued or renewed after July 16, 2003, shall conform with the requirements of the Women's Health and Cancer Rights Act of 1998, 42 U.S.C. §§ 300gg-6 and 300gg-52, as it existed on January 1, 2003.

(b)  To the extent the requirements of this section do not conflict with federal law, rules, or regulations, each health care insurer providing mastectomy benefits in a health benefit plan shall provide, in a manner determined in consultation with the attending physician and the enrollee or insured:

            (1)  For medical and surgical benefits for any hospital stay in connection with a mastectomy for not less than forty-eight (48) hours unless the decision to discharge the patient before the expiration of the minimum length of stay is made by an attending physician in consultation with the enrollee or insured;

            (2)  The following medical and surgical benefits with respect to mastectomy coverage if an enrollee or insured receives benefits in connection with a mastectomy and elects breast reconstruction:

                        (A)  Surgery and reconstruction of the breast on which the mastectomy has been performed;

                        (B)  Surgery and reconstruction of the other breast to produce a symmetrical appearance; and

                        (C)  Prostheses and coverage for physical complications at all stages of a mastectomy, including lymphedemas; and

            (3)  Written notice of the availability of coverage under this section to the enrollee or insured upon enrollment and annually thereafter.

(c)  No health care insurer providing mastectomy benefits under this section shall:

            (1)  Deny an enrollee or insured eligibility or continued eligibility to enroll or renew coverage under the terms of the health plan solely for the purpose of avoiding the requirements of this section; or

            (2)  Penalize, reduce, or limit the reimbursement of an attending provider or induce the provider to provide care in a manner inconsistent with this section.

 

23-99-406. Obstetrical and gynecological services.

 

(a)  In order to ensure that health care benefits are safely and appropriately delivered to women, insurers which require the selection or assignment of a primary care physician shall allow each covered person who is a woman to select a participating obstetrician/gynecologist in addition to her primary care physician.

(b)  If the woman chooses to make this selection, the insurer shall allow the woman to go directly to her selected obstetrician/gynecologist, without referral from her primary care physician, for obstetrical and gynecological services.

 

23-99-407. “Gag clause” prohibition.

 

No participating provider may be prohibited, restricted, or penalized in any way from disclosing to any covered person any health care information that the provider deems appropriate regarding the nature of treatment, risks, or alternatives thereto, the availability of alternate therapies, consultations, or tests, the decision of utilization reviewers or similar persons to authorize or deny services, the process that is used to authorize or deny health care services or benefits, or information on financial incentives and structures used by the insurer.

 

23-99-408. Continuity of care.

 

(a)  When health care insurers use participating providers, the insurers shall develop procedures to provide for the continuity of care of their covered persons. At a minimum, the procedures shall:

            (1)  Ensure that when a new patient is enrolled in a health benefit plan and is being treated by a nonparticipating provider for a current episode of an acute condition, the patient may continue to receive treatment as an in-network benefit from that provider until the current episode of treatment ends or until the end of ninety (90) days, whichever occurs first;

            (2)  Ensure that when a provider's participation is terminated, his or her patients under the plan may continue to receive care from that provider as an in-network benefit until a current episode of treatment for an acute condition is completed or until the end of ninety (90) days, whichever occurs first; and

            (3)  Explain how the covered person may request to continue services under subdivisions (a)(1) and (2) of this section.

(b)  During the period covered by subdivisions (a)(1) and (2) of this section, the provider shall be deemed to be a participating provider for purposes of reimbursement, utilization management, and quality of care.

(c)  Nothing in this section shall require a health care insurer to provide benefits that are not otherwise covered under the terms and provisions of the plan.

 

23-99-409. Prescription drug formulary.

 

When a health care insurer uses a formulary for prescription drugs, the insurer shall include a written procedure whereby covered persons can obtain, without penalty and in a timely fashion, specific drugs and medications not included in the formulary when:

            (1)  The formulary's equivalent has been ineffective in the treatment of the covered person's disease or condition; or

            (2)  The formulary's drug causes or is reasonably expected to cause adverse or harmful reactions in the covered person.

 

23-99-410. Grievance procedures.

 

(a)  A health care insurer issuing or delivering a managed care plan shall establish for those managed care plans a grievance procedure which provides covered persons with a prompt and meaningful review on the issue of denial, in whole or in part, of a health care treatment or service.

(b)(1)  The covered person shall be provided prompt notice in writing of the outcome of the grievance procedure.

            (2)  In the event the outcome is adverse to the covered person, the notice shall include specific findings related to the grievance.

 

23-99-411. Processing applications of providers.

 

(a)(1)(A)  Health care insurers shall establish mechanisms to ensure timely processing of requests for participation or renewal by providers and in making decisions that affect participation status.

                        (B)  These mechanisms shall include, at a minimum, provisions for the provider to receive a written statement of reasons for the health care insurer’s denial of a request for initial participation or renewal.

            (2)(A)  Health care insurers shall make a decision within:

                                    (i)  Ninety (90) calendar days from the date of submission of a completed application as defined by rule of the Insurance Commissioner for participation or a request for renewal by a physician licensed under the Arkansas Medical Practices Act, § 17-95-201 et seq., § 17-95-301 et seq., and § 17-95-401 et seq.; and

                                    (ii)  One hundred eighty (180) calendar days from the date of submission of a completed application as defined by rule of the commissioner for participation or a request for renewal by any other provider.

                        (B)  However, when a physician’s credentials are verified through the Arkansas State Medical Board’s Centralized Credentials Verification Service under § 17-95-107, the ninety (90) days specified under subdivision (a)(2)(A)(i) of this section is tolled from the date an order is received by the Centralized Credentials Verification Service from the health care insurer until the date the health care insurer receives notification by the Centralized Credentials Verification Service that the file is complete and available for retrieval.

                        (C)(i)  If the information provided by the initial application, the health care insurer’s investigation, or the Centralized Credentials Verification Service requires the health care insurer to collect more detailed information from the provider to fairly and responsibly process the application, the time specified under subdivision (a)(2)(A)(i) of this section is tolled and the application is suspended from the date a written request for the information is sent to the provider until the request is fully and completely answered and sent to the health care insurer by the provider.

                                    (ii)  If the request is not fully answered within ninety (90) days of the date it was sent, the health care insurer, in its discretion, may treat the application as abandoned and deny it.

                                    (iii)  The request and response under this section shall be sent by regular mail or other means of delivery as may be allowed by rules adopted by the commissioner.

            (3)  If a physician is already credentialed by the health insurer but changes employment or changes location, the health insurer shall only require the submission of such additional information, if any, as is necessary to continue the physician’s credentials based upon the changed employment or location.

            (4)  Health care insurers shall promptly notify providers:

                        (A)  Of any delay in processing applications; and

                        (B)  The reasons for a delay in processing applications.

            (5)  The commissioner may adopt rules to ensure that covered health care claims submitted by patients or their providers are not negatively affected by delays in processing participation applications.

            (6)  The commissioner shall adopt rules to implement this subsection.

(b)  Nothing in this section shall prevent a provider or a health care insurer from terminating a participating provider contract in accordance with its terms.

 

23-99-412. Provider input.

 

All health care insurers issuing or delivering managed care plans shall be required to establish a mechanism whereby participating providers provide input into the insurer's medical policy, utilization review criteria and procedures, quality and credentialing criteria, and medical management procedures.

 

23-99-413. Disclosure requirements.

 

Upon request, health care insurers must provide the following information in a clear and understandable form to all prospective policyholders, policyholders, and covered persons. Insurers shall notify policyholders and covered persons of their right to request the information, which must include:

            (1)  Coverage provisions, benefits, and exclusions by category of service and provider;

            (2)  A description of the prior authorization, precertification, and referral requirements;

            (3)  The existence of prescription drug formularies and prior approval requirements for prescription drugs;

            (4)  The name, number, type, specialty, and geographic location of participating providers; and

            (5)(A)  Criteria by which providers are evaluated for network participation.

                        (B)  Proprietary information shall not be disclosed.

                        (C)  Criteria may include, but are not limited to, geographic limitations, geographic distribution of patients, specialty limitation, anticipated numbers and types of providers needed, and economic considerations. This information shall also be made available to providers upon request.

 

23-99-414. Regulations.

 

The Insurance Commissioner may promulgate necessary rules and regulations for carrying out this subchapter.

 

23-99-415. Enforcement and penalties.

 

The Insurance Commissioner shall have all the powers to enforce this subchapter as are granted to the commissioner elsewhere in the Arkansas Insurance Code.

 

23-99-416. Application of subchapter.

 

This subchapter applies to all health benefit plans issued, renewed, extended, or modified on or after August 1, 1997. “Renewed, extended, or modified” shall include all health benefit plans in which the insurer has reserved the right to change the premium.

 

23-99-417. Coverage required for orthotic devices, orthotic services, prosthetic devices, and prosthetic services.

 

(a)(1)  Subject to subdivision (a)(2) of this section and subsections (b) and (c) of this section, a health benefit plan that is issued for delivery, delivered, renewed, or otherwise contracted for in this state shall provide coverage for eligible charges within limits of coverage that are no less than eighty percent (80%) of Medicare allowables as defined by the Centers for Medicare & Medicaid Services, Healthcare Common Procedure Coding System as of January 1, 2009, or as of a later date if adopted by rule of the Insurance Commissioner for:

                        (A)  An orthotic device;

                        (B)  An orthotic service;

                        (C)  A prosthetic device; and

                        (D)  A prosthetic service.

            (2)  This section does not require coverage for an orthotic device, an orthotic service, a prosthetic device, or a prosthetic service for a replacement that occurs more frequently than one (1) time every three (3) years unless medically necessary or indicated by other coverage criteria.

(b)(1)  Eligible charges and limits of or exclusions from coverage under subsection (a) of this section shall be based on medical necessity or the health benefit plan’s coverage criteria for other medical services, which may include without limitation:

                        (A)  The information and recommendation from the treating physician in consultation with the insured; and

                        (B)  The results of a functional limit test.

            (2)  As used in this section, “functional limit test” includes without limitation the insured’s:

                        (A)  Medical history, including prior use of orthotic devices or prosthetic devices if applicable;

                        (B)  Current condition, including the status of the musculoskeletal system and the nature of other medical problems; and

                        (C)  Desire to:

                                    (i)  Ambulate with respect to lower-limb orthotic devices or prosthetic devices; or

                                    (ii)  Maximize upper-limb function with respect to upper-limb orthotic devices or prosthetic devices.

            (3)  A denial or limitation of coverage based on lack of medical necessity is subject to external review under State Insurance Department Rule 76, the Arkansas External Review Regulation.

(c)  A health benefit plan:

            (1)  May require prior authorization for an orthotic device, an orthotic service, a prosthetic device, or a prosthetic service in the same manner that prior authorization is required for any other covered benefit;

            (2)  May impose copayments, deductibles, or coinsurance amounts for an orthotic device, an orthotic service, a prosthetic device, or a prosthetic service if the amounts are no greater than the copayments, deductibles, or coinsurance amounts that apply to other benefits under the health benefit plan;

            (3)  When the replacement or repair is necessitated by anatomical change or normal use, shall cover the necessary repair and necessary replacement of an orthotic device or a prosthetic device subject to copayments, coinsurance, and deductibles that are no more restrictive than the copayments, coinsurance, and deductibles that apply to other benefits under the plan, unless the repair or replacement is necessitated by misuse or loss; and

            (4)  Shall include a requirement that an orthotic device, an orthotic service, a prosthetic device, or a prosthetic service be prescribed by a licensed doctor of medicine, doctor of osteopathy, or doctor of podiatric medicine and provided by a doctor of medicine, a doctor of osteopathy, a doctor of podiatric medicine, an orthotist, or a prosthetist licensed by the State of Arkansas.

(d)  Coverage of an orthotic device, an orthotic service, a prosthetic device, or a prosthetic service may be made subject to but no more restrictive than the provisions of the health benefit plan that apply to other benefits under the plan.

 

Subchapter 5 — Arkansas Mental Health Parity Act

 

23-99-501. Short title.

 

This subchapter shall be known and may be cited as the “Arkansas Mental Health Parity Act of 2009”.

 

23-99-502. Legislative findings and intent.

 

It is the intent of this state that if a health benefit plan provides insurance coverage for a mental illness or substance abuse disorder, the treatment of the mental illness or substance abuse disorder shall be as available as and at parity with that for other medical illnesses.

 

23-99-503. Definitions.

 

As used in this subchapter:

            (1)  “Carve-out arrangement” means an arrangement in which a health care insurer contracts with a separate person or entity to arrange for the delivery of specific types of health care benefits under a health benefit plan;

            (2)  “Commissioner” means the Insurance Commissioner;

            (3)  “Financial requirements” means copayments, deductibles, out-of-network charges, out-of-pocket contributions or fees, annual limits, lifetime aggregate limits imposed on individual patients, and other patient cost-sharing amounts;

            (4)  “Health benefit plan” means any group or blanket plan, policy, or contract for health care services issued or delivered in this state by health care insurers, including indemnity and managed care plans and the plans providing health benefits to state and public school employees pursuant to § 21-5-401 et seq., but excluding plans providing health care services pursuant to Arkansas Constitution, Article 5, § 32, the Workers’ Compensation Law, § 11-9-101 et seq., and the Public Employee Workers’ Compensation Act, § 21-5-601 et seq.;

            (5)  “Health care insurer” means any insurance company, hospital and medical service corporation, or health maintenance organization issuing or delivering health benefit plans in this state and subject to any of the following laws:

                        (A)  The Arkansas Insurance Code;

                        (B)  Section 23-75-101 et seq., pertaining to hospital and medical service corporations;

                        (C)  Section 23-76-101 et seq., pertaining to health maintenance organizations; and

                        (D)  Any successor law of the foregoing;

            (6)(A)  “Mental illnesses” and “substance use disorders” mean those illnesses and disorders that are covered by a health benefit plan listed in the International Classification of Diseases Manual and the Diagnostic and Statistical Manual of Mental Disorders.

                        (B)  Unless specifically otherwise stated, “mental illness” includes substance use disorders;

            (7)  “Person” or “entity” means and includes, individually and collectively, any individual, corporation, partnership, firm, trust, association, voluntary organization, or any other form of business enterprise or legal entity; and

            (8)  “Small employer” means any person or entity actively engaged in business who, on at least fifty percent (50%) of its working days during the preceding year, employed no more than fifty (50) eligible employees.

 

23-99-504. Exclusions.

 

This subchapter does not apply to:

            (1)  Dental insurance plans;

            (2)  Vision insurance plans;

            (3)  Specified-disease insurance plans;

            (4)  Accidental injury insurance plans;

            (5)  Long-term care plans;

            (6)  Disability income plans;

            (7)  Individual health benefit plans if the health care insurers offer individuals who satisfy the health care insurer’s underwriting standards the option of purchasing a plan that, other than being optional, meets all the other requirements of this subchapter;

            (8)  Health benefit plans for small employers if the health care insurers offer purchasers the option of purchasing a plan that, other than being optional, meets all the other requirements of this subchapter; and

            (9)  Medicare supplement plans, as subject to section 1882(g)(1) of the Social Security Act.

 

23-99-505. Increased cost exemption.

 

(a)(1)  This subchapter does not apply to a health benefit plan during the health benefit plan’s following health benefit plan year if the application of this subchapter to the health benefit plan in a health benefit plan year resulted in an increase in the actual costs of coverage with respect to medical and surgical benefits and mental illness benefits under the health benefit plan as determined and certified under subsection (b) of this section by an amount that exceeds:

                        (A)  Two percent (2%) for the first health benefit plan year in which this section is applied; or

                        (B)  One percent (1%) for each subsequent health benefit plan year.

            (2)  The exemption provided by subdivision (a)(1) of this section applies to a health benefit plan for one (1) year.

            (3)  A health care insurer may elect to continue to apply mental health parity under this subchapter to its health benefit plans regardless of any increase in its total costs of coverage.

(b)(1)  A determination under this section of increases to the actual costs of coverage of a health benefit plan shall be made and certified by a qualified and licensed actuary who is a member in good standing of the American Academy of Actuaries.

            (2)  The determination shall be in a written report prepared by the actuary.

            (3)  The report and all underlying documentation relied upon by the actuary shall be maintained by the health care insurer for a period of six (6) years following the notification required by subsection (d) of this section.

(c)  To obtain an exemption under this section, a health care insurer shall make the increased cost determination required by this section after the health benefit plan has complied with this section for the first six (6) months of the health benefit plan year.

(d)(1)  A health care insurer that elects to claim an exemption for a qualifying health benefit plan under this section based upon a certification under subsection (b) of this section shall promptly notify the Insurance Commissioner, the policyholder or contract holder, and the certificate holders, subscribers, and enrollees covered by the health benefit plan of its election.

            (2)  The notification to the commissioner under subdivision (d)(1) of this section shall include:

                        (A)  A description of the number of covered lives under the health benefit plan at the time of the notification and, if applicable, at the time of any prior election of the increased cost exemption under this section; and

                        (B)  For the current and previous health benefit plan year:

                                    (i)  A description of the actual total costs of coverage for medical and surgical benefits and mental illness benefits under the health benefit plan; and

                                    (ii)  The actual total costs of coverage with respect to mental illness benefits under the health benefit plan.

            (3)(A)  A notification under this subsection is confidential.

                        (B)  The commissioner shall make available upon request, but not more than annually, an anonymous itemization of notifications under this section that includes a summary of the data received under subdivision (d)(2) of this section.

(e)  To determine compliance with this section, the commissioner may audit the books and records of a health care insurer relating to an exemption, including without limitation any actuarial reports prepared pursuant to subsection (b) of this section during the six-year period following the notification required by subsection (d) of this section.

(f)  The commissioner may promulgate rules to implement this section.

 

23-99-506. Parity requirements.

 

(a)  Except as provided in § 23-99-504, a health benefit plan that provides benefits for the diagnosis and treatment of mental illnesses shall provide the benefits under the same terms and conditions as provided for covered benefits offered under the health benefit plan for the treatment of other medical illnesses and conditions, including without limitation:

            (1)  The duration or frequency of coverage;

            (2)  The dollar amount of coverage; or

            (3)  Financial requirements.

(b)  This subchapter does not:

            (1)  Require equal coverage between treatments for a mental illness with coverage for preventive care;

            (2)  Prohibit a health care insurer from:

                        (A)  Negotiating separate reimbursement rates and service delivery systems, including without limitation a carve-out arrangement;

                        (B)  Managing the provision of mental health benefits for mental illnesses by common methods used for other medical conditions, including without limitation preadmission screening, prior authorization of services, or other mechanisms designed to limit coverage of services or mental illnesses to mental illnesses that are deemed medically necessary;

                        (C)  Limiting covered services to covered services authorized by the health benefit plan, if the limitations are made in accordance with this subchapter;

                        (D)  Using separate but equal cost-sharing features for mental illnesses; or

                        (E)  Using a single lifetime or annual dollar limit as applicable to other medical illness; and

            (3)  Include a Medicare or Medicaid plan or contract or any privatized risk or demonstration program for Medicare or Medicaid coverage.

 

23-99-507. Medical necessity.

 

(a)  The criteria for medical necessity determinations for mental illness made under a health benefit plan shall be made available by the health care insurer in accordance with rules established by the Insurance Commissioner to any current or potential covered individual or contracting provider upon request.

(b)  On request, the reason for a denial of reimbursement or payment for services to diagnose or treat mental illness under a health benefit plan shall be made available by the health care insurer to a covered individual in accordance with the rules of the commissioner.

 

23-99-508. Permitted provisions.

 

(a)  A health care insurer may at the insurer's option provide coverage for a health service, such as intensive case management, community residential treatment programs, or social rehabilitation programs, that is used in the treatment of mental illnesses, but is generally not used for other injuries, illnesses, and conditions, if the other requirements of this subchapter are met.

(b)  Health care insurers providing educational remediation may, but are not required to, comply with the terms of this subchapter in regard to the treatment or remediation.

(c)  A health care insurer may provide coverage for a health service, including without limitation physical rehabilitation or durable medical equipment, which generally is not used in the diagnosis or treatment of serious mental illnesses, but is used for other injuries, illnesses, and conditions, as long as the other requirements of this subchapter are met.

(d)  A health care insurer may utilize common utilization management protocols, including without limitation preadmission screening, prior authorization of service, or other mechanisms designed to limit coverage of service for mental illness to individuals whose diagnosis or treatment coverage is considered medically necessary although the protocols are not used in conjunction with other medical illnesses or conditions covered by the health benefit plan.

 

23-99-509. Applicability.

 

(a)  On or after October 3, 2009, this subchapter shall apply to health benefit plans on the health benefit plans' anniversaries or start dates but in no event later than one (1) year after October 3, 2009.

(b)  If a health benefit plan provides coverage or benefits to an Arkansas resident, the health benefit plan shall be deemed to be delivered in this state within the meaning of this subchapter, regardless of whether the health care insurer or other entity that provides the coverage is located within or outside Arkansas.

 

23-99-510. Rules and regulations.

 

The Insurance Commissioner shall enforce this subchapter and shall promulgate necessary rules and regulations for carrying out this subchapter.

 

23-99-511. Enforcement.

 

The Insurance Commissioner shall have all the powers to enforce this subchapter as are granted to the commissioner elsewhere in the Arkansas Insurance Code.

 

23-99-512. Out-of-network providers.

 

In the case of a health benefit plan that provides both medical benefits and mental illness benefits, if the health benefit plan provides coverage for medical benefits provided by out-of-network providers, the health benefit plan shall provide coverage for mental illness benefits provided by out-of-network providers pursuant to this subchapter.

 

Subchapter 6 — Dental Point of Service Act

 

23-99-601. Short title.

 

This subchapter shall be cited as the “Dental Point of Service Act”.

 

23-99-602. Legislative findings.

 

The General Assembly finds that the quality of dental care is improved through patient choice among dentists and that utilization of dentists varies less than utilization of other providers. Patients should have the freedom to go to dentists outside their managed care network when the carrier is not required to pay the dentist more than it pays in-network dentists. Therefore, health carriers should be required to offer a point-of-service option for dental care.

 

23-99-603. Definitions.

 

As used in this subchapter:

            (1)  “Commissioner” means the Insurance Commissioner;

            (2)  “Covered person” means a person covered by a health plan including an enrollee, subscriber, policyholder, beneficiary of a group plan, or individual covered by any other health plan;

            (3)  “Dentist” means a person licensed under the Arkansas Dental Practice Act, § 17-82-101 et seq.;

            (4)  “Health care service” means that service offered or provided by the health care providers within the scope of their practice and relating to the prevention, cure, or treatment of illness or disease;

            (5)  “Health carrier” means any insurance company, health maintenance organization, or hospital and medical service corporation as defined in § 23-75-101, subject to the following laws:

                        (A)  The Arkansas Insurance Code;

                        (B)  Provisions pertaining to health maintenance organizations, § 23-76-101 et seq.; and

                        (C)  Any successor laws of the foregoing; and

            (6)  “Health plan” means any policy, contract, or agreement offered by a health carrier to provide, reimburse, or pay for health care services except the following:

                        (A)  Workers' compensation coverage;

                        (B)  Self-funded or self-insured health plans, unless the plan is established or maintained for employees of a governmental entity; and

                        (C)  A policy, contract, or agreement that limits coverage for dental services in connection with the treatment of a covered accidental injury or the treatment of a nondental physiological condition.

 

23-99-604. Coverage for out-of-network dentists.

 

(a)  Every health plan which provides dental benefits issued, renewed, extended, or modified by a health carrier shall also include a point-of-service option which provides benefits to covered persons through dentists who are not members of the carrier's provider network.

(b)(1)  The benefits offered under this option shall be the same as those offered through the network.

            (2)  The rate of reimbursement for out-of-network dentists may differ from the rate of reimbursement for noncapitated dentists in the network but by no more than ten percent (10%).

            (3)  The copayment, coinsurance, and other cost-sharing features may differ between the use of in-network and out-of-network dentists but by no more than twenty-five percent (25%).

(c)  The out-of-network dentist may bill the patient for the balance of any charges which are not otherwise reimbursed by the health carrier. However, if after a request by the covered person in advance of treatment the provider fails to disclose a reasonable range of the total of charges for nonemergency services to be provided, the covered person shall not be liable for such additional charges.

(d)  The health carrier shall fully disclose to the covered person, in clear, understandable language, the terms and conditions of this option. This requirement may be satisfied by the health carrier's providing to the employer or other purchaser of the plan presentation materials for dissemination to covered persons.

 

23-99-605. Rules and regulations.

 

Within one hundred twenty (120) days of July 30, 1999, the Insurance Commissioner shall promulgate necessary rules and regulations for carrying out this subchapter, giving maximum possible effect to the General Assembly's intent to promote quality medical care through increased choice.

 

23-99-606. Insurance Commissioner's enforcement authority.

 

The Insurance Commissioner shall enforce this subchapter, using the powers granted to the commissioner elsewhere in the Arkansas Insurance Code.

 

23-99-607. Duty of Attorney General to defend.

 

In any legal proceeding in which the validity of this subchapter is challenged, the Attorney General shall defend the subchapter regardless of the state agency or official named as an official party.

 

23-99-608. Applicability of subchapter.

 

This subchapter applies to health plans issued, renewed, extended, or modified by a health carrier on or after July 30, 1999. “Renewed, extended, or modified” shall include a change in premium or other financial term.

 

Subchapter 7 — Grievance Systems and Quality Assessment and Improvement Systems

 

23-99-701. Legislative findings.

 

The General Assembly finds and declares the following:

            (1)  The State of Arkansas has an interest in protecting its citizens and in pursuing reasonable means to improve the quality of life and health of those citizens;

            (2)  In the health care field, the State of Arkansas has traditionally regulated utilization review as well as the quality of care provided by health care providers, insurance companies, and organizations which assume the risk of providing health care services for citizens of this state, such as health maintenance organizations; and

            (3)  Dynamic changes in how health care is delivered to citizens of this state require the state to oversee the quality of health care processes and outcomes resulting from health carriers and networks.

 

23-99-702. Definitions.

 

As used in this subchapter:

            (1)  “Commissioner” means the Insurance Commissioner;

            (2)  “Director” means the Director of the Department of Health;

            (3)  “Health care services” means any services included in the furnishing to any individual of medical or dental care, hospitalization, or services incident to the furnishing of care or hospitalization, as well as the furnishing to any person of any and all other services or goods for the purpose of preventing, alleviating, curing, or healing human illness or injury;

            (4)  “Health carrier” means any person who undertakes to provide or arrange for one (1) or more managed care plans;

            (5)  “Managed care plan” means any arrangement whereby a health carrier undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any health care services, and at least part of the arrangement consists of arranging for or the provision of health care services as distinguished from mere indemnifications against the cost of the services on a prepaid basis through insurance or otherwise; and

            (6)  “Network” when used to describe a provider of health services, including, but not limited to, a hospital, physician, home health agency, pharmacy, etc., means that the provider has a participation agreement in effect with a health carrier, directly or through another entity, to provide health services to covered persons.

 

23-99-703. Grievance system.

 

(a)  All health carriers and networks shall make arrangements for handling and resolving grievances.

(b)  Each health carrier and network shall:

            (1)  Maintain records of grievances filed with the health carrier and network concerning the quality of health care services; and

            (2)  Submit in the form and manner prescribed by the Director of the Department of Health a periodic report which shall include:

                        (A)  A written description of the processes and procedures for resolving grievances; and

                        (B)  The total number of grievances handled through the grievance system, including a compilation of the dates of the grievances, the reason for the grievances, and resolutions of each grievance.

(c)  In consultation with the Insurance Commissioner, the director may promulgate rules and regulations in accordance with the Arkansas Administrative Procedure Act, § 25-15-201 et seq., to carry out the provisions of this subchapter to enable the state to be properly informed of quality issues within the state and to adequately respond to any quality concerns expressed through grievances.

 

23-99-704. Quality assessment and improvement systems.

 

(a)  Each health carrier and network shall:

            (1)  Make arrangements for measuring and improving the quality of health care services;

            (2)  Maintain quality assessment and improvement programs and records measuring the outcomes of health care services; and

            (3)  Submit to the Director of the Department of Health in the time, manner, and form prescribed the following information:

                        (A)  A written description of any quality assessment and quality improvement systems; and

                        (B)  Findings of relevant quality data as determined by the director.

(b)  In consultation with the Insurance Commissioner, the director may promulgate rules and regulations in accordance with the Arkansas Administrative Procedure Act, § 25-15-201 et seq., to carry out the provisions of this subchapter to enable the state to be properly informed of quality issues within the state and to adequately respond to any quality concerns found through the outcome data.

(c)  The provisions of §§ 16-46-105 and 20-9-501 et seq. shall apply to all records maintained pursuant to this subchapter.

 

23-99-705. Applicability and scope.

 

(a)  This subchapter shall not apply to disability income, specified disease, medicare supplement, hospital indemnity, accident-only policies, long-term care, short-term limited duration insurance, and all other supplemental insurance products issued by health carriers.

(b)  In terms of the Director of the Department of Health's regulatory authority pursuant to §§ 23-99-703 and 23-99-704, such authority shall apply to the quality of care provided by health carriers and networks operating in this state and shall not apply to the benefits offered by any health carrier and network or to the administration of such benefits.

 

23-99-706. Enforcement and penalties.

 

The Director of the Department of Health shall have the power to implement and enforce this subchapter.

 

Subchapter 8 — Enforcement of Any Willing Provider Laws

 

23-99-801. Application and intent.

 

(a)  The state's any willing provider laws shall not be construed:

            (1)  To require all physicians or a percentage of physicians in the state or a locale to participate in the provision of services for a health maintenance organization; or

            (2)  To take away the authority of health maintenance organizations that provide coverage of physician services to set the terms and conditions for participation by physicians, though health maintenance organizations shall apply the terms and conditions in a nondiscriminatory manner.

(b)(1)  The state's any willing provider laws shall apply to:

                        (A)  All health insurers, regardless of whether they are providing insurance, including prepaid coverage, or administering or contracting to provide provider networks; and

                        (B)  All multiple-employer welfare arrangements and multiple-employer trusts.

            (2)  This subsection shall apply only to the extent permitted by ERISA, the federal Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq.

(c)(1)  The state's any willing provider laws shall be construed to include within their provider definitions all those providers of the same class or classes who are:

                        (A)  Practicing or operating within a border city in an adjoining state; and

                        (B)  Licensed or authorized to practice or operate by the adjoining state, regardless of whether the provider is licensed or otherwise authorized to operate in Arkansas.

            (2)  As used in this section, “border city” means a city in a state adjoining Arkansas which adjoins the Arkansas state line and is not separated from an Arkansas city only by a navigable river.

(d)(1)  As clarification, nothing in the state's any willing provider laws shall be construed to cover or regulate health care provider networks offered by noninsurers.

            (2)  If an employer sponsoring a self-insured health benefit plan contracts directly with providers or contracts for a health care provider network through a noninsurer, then the any willing provider law does not apply.

            (3)  If a health insurer subcontracts with a noninsurer whose health care network does not meet the requirements of the any willing provider law, then the noninsurer may create a separate health care provider network that meets the requirements of the any willing provider law.

            (4)  If the noninsurer chooses not to create the separate health care provider network, then the responsibility for compliance with the any willing provider law is the obligation of the health insurer to the extent permitted by ERISA, the federal Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq.

(e)  Notwithstanding the provisions of subsection (d) of this section, the Patient Protection Act of 1995, § 23-99-201 et seq., and this subchapter apply to a health benefit plan provided by the State of Arkansas to state employees and public school personnel under § 21-5-401 et seq., whether self-funded or insured.

 

23-99-802. Definitions.

 

As used in this subchapter:

            (1)  “Any willing provider law” means a law that prohibits discrimination against a provider willing to meet the terms and conditions for participation established by a health insurer or that otherwise precludes an insurer from prohibiting or limiting participation by a provider who is willing to accept a health insurer's terms and conditions for participation in the provision of services through a health benefit plan;

            (2)  “ERISA” means the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq.;

            (3)  “Health benefit plan” means any health insurance policy or certificate, health maintenance organization contract, hospital and medical service corporation contract or certificate, a self-insured plan or a plan provided by a multiple employer welfare arrangement, to the extent permitted by ERISA, the Employee Retirement Income Security Act of 1974, as amended, 29 U.S.C. § 1001 et seq., or any health benefit plan that affects the rights of an Arkansas insured and bears a reasonable relation to Arkansas, whether delivered or issued for delivery in Arkansas;

            (4)  “Health care provider” or “provider” means those individuals or entities licensed by the State of Arkansas to provide health care services, limited to the following:

                        (A)  Advanced practice nurses;

                        (B)  Athletic trainers;

                        (C)  Audiologists;

                        (D)  Certified orthotists;

                        (E)  Chiropractors;

                        (F)  Community mental health centers or clinics;

                        (G)  Dentists;

                        (H)  Home health care;

                        (I)  Hospice care;

                        (J)  Hospital-based services;

                        (K)  Hospitals;

                        (L)  Licensed ambulatory surgery centers;

                        (M)  Licensed certified social workers;

                        (N)  Licensed dieticians;

                        (O)  Licensed durable medical equipment providers;

                        (P)  Licensed professional counselors;

                        (Q)  Licensed psychological examiners;

                        (R)  Long-term care facilities;

                        (S)  Occupational therapists;

                        (T)  Optometrists;

                        (U)  Pharmacists;

                        (V)  Physical therapists;

                        (W)  Physicians and surgeons (M.D. and D.O.);

                        (X)  Podiatrists;

                        (Y)  Prosthetists;

                        (Z)  Psychologists;

                        (AA)  Respiratory therapists;

                        (BB)  Rural health clinics;

                        (CC)  Speech pathologists; and

                        (DD)  Other health care practitioners as determined by the department in regulations promulgated under the Arkansas Administrative Procedure Act, § 25-15-201, et seq.;

            (5)  “Health insurer” or “health care insurer” means any entity that is authorized by the State of Arkansas to offer or provide health benefit plans, policies, subscriber contracts, or any other contracts of a similar nature which indemnify or compensate health care providers for the provision of health care services;

            (6)  “Noninsurer” means an entity that is not required to obtain authorization from the department to do business as a health insurer but that does have a provider network; and

            (7)  “Self-insured” includes self-funded and vice versa.

 

23-99-803. Agency enforcement.

 

The Insurance Commissioner shall:

            (1)  Enforce the state's any willing provider laws using powers granted to the commissioner in the Arkansas Insurance Code; and

            (2)  Be entitled to seek an injunction against a health insurer in a court of competent jurisdiction.